Wednesday, February 24, 2010

This is a disaster directly lying inside Number 10 Downing Street. It was they that created Foundation Hospital trusts (plus the spineless MPs). They that created the purchaser-provider split. They that founded Monitor who were only interested in financial success.

No, Messrs Brown, Blair, Burnham and all the others: this is not a local problem. It is being replicated at a hospital trust near you.

The fault lies with policy and the labour Government. It is people at the top that need to resign. Except that they won't, of course.

Patients were “routinely neglected” at an NHS hospital where hundreds of deaths resulted from appalling care, an independent inquiry found today.

Mid Staffordshire NHS Foundation Trust lost sight of its responsibility to provide safe care because it was preoccupied with cost-cutting and meeting Government targets, a report said.

The inquiry, by Robert Francis, QC, made 18 recommendations for the trust and the wider NHS after hearing evidence from more than 900 patients and families.

Regulators revealed last year that between 400 and 1,200 more people had died at Mid Staffordshire Trust than would be expected between 2005 and 2008, in one of the worst examples of poor care in the history of the NHS.

The trust said that it would consider whether individual nurses or doctors should face further disciplinary action.

He said evidence gathered during the inquiry into events at the trust between January 2005 and March 2009 had shown clearly that for many patients the most basic elements of care were neglected.

Patients were left unwashed, at times for up to a month, and food and drinks were left out of reach of patients.

“We understand both the sadness and sorrow of the relatives who lost their loved ones,” he said. “It was a management failure and completely unacceptable.”

He added that the Government was taking steps to better regulate hospitals and would introduce the power to “strike off” managers who were unfit to work in the NHS.

Concerning Mid-Staffordshire NHS Trust, the chairman of theHealthcare Commission indicated that warnings existed aboutsome of its problems for years before the problems became publiclyknown.11 Why should staff accept the risks of whistleblowingif warnings are ignored?

The chairman of the Care Quality Commission has criticised staffat Mid-Staffordshire NHS Trust and elsewhere for operating ina "culture of silence."9But the commission’s plan toassess progress at Stafford does not mention whistleblowers.The secretary of state for health has stated: "I do not understandwhy clinicians whose primary role is the safety of their patientsare somehow concerned about whistleblowing."12

T8. [265644] Michael Fabricant (Lichfield) (Con): Two constituents came to my surgery a few weeks ago to talk to me about a hospital in the west midlands— not Mid-Staffordshire hospital. They showed me photographs of mouse holes, mouse droppings in the operating theatre and blood smeared in wards. One is a consultant surgeon and both were frightened of being whistleblowers and feared for their jobs. What sort of ethos exists in the health service if people like that can be afraid of revealing the truth?

Alan Johnson: I know about that case, because the hon. Gentleman dropped me a note about it after the debate last week, and I am looking into it. As he did not mention the hospital, neither will I, but the fact that he has now placed the matter on record allows me to respond to him more formally than I would otherwise have done.

I do not understand why clinicians whose primary role is the safety of their patients are somehow concerned about whistleblowing. Indeed, knowing the number of people in various occupations who are not slow to make people aware of such difficulties, it amazes me that that did not happen at Stafford. The hon. Gentleman has taken a great interest in the matter, and I shall make absolutely sure that the issue that he has raised with me is thoroughly examined. Incidentally, I would also like to talk to the consultant concerned to find out why they were so frightened to raise the matter.

Tuesday, February 23, 2010

First published March 1, 2008

(One shouldeat to live and not live to eat.)
-Moliere (1622 – 1673): L'Avare (The Miser)

Some hae(have)meat and cannot eat,
Some cannot eat that want it:
But we hae meatand we can eat,
Sae let the Lord be thankit.
-Robert Burns (1759 – 1796): The Kirkcudbright Grace

This is not about Stephen Hawking’s famousbookthat sold over 9m copies world-wide, but a collection of material that relates to Anorexia Nervosa in a chronological order. You see, I believe in free sharing of knowledge.

“In… 1868, I referred to a peculiar form of disease occurring mostly in young women, and characterized by extreme emaciation…. At present our diagnosis of this affection is negative, so far as determining any positive cause from which it springs…. The subjects…are…chiefly between the ages of sixteen and twenty-three…. My experience supplies at least one instance of a fatal termination…. Death apparently followed from the starvation alone…. The want of appetite is, I believe, due to a morbid mental state…. We might call the state hysterical.”

Hundreds of people taking Avandia, a controversial diabetes medicine, needlessly suffer heart attacks and heart failure each month, according to confidential government reports that recommend the drug be removed from the market.

Avandia, intended to treat Type 2 diabetes, is known as rosiglitazone and was linked to 304 deaths during the third quarter of 2009.

Bottlenose dolphinshavewhat could be called type 2 diabetes, but unlike humans, the animalsare able to turn it off and on—perhaps an evolutionary adaptation to maintain their bigbrains, new research suggests.

Bottlenose Dolphin. NOAA image

Diabetes may have arisen in Ice Age humans for similar reasons, so the newfound dolphin on-off switch may be a key to curing type 2 diabetes in people.

Like humans, dolphins have relatively large brains compared to their body sizes—in fact, dolphins are second only to humans in the ratio between body and brain size.

Scientists know that humans need plenty of a sugar called glucose to keep their .brains functioning. Some researchers thinkthe same might be true for dolphins, since both species send high amounts of glucose through their bloodstreams.

Dolphins, however, primarily eat fish, which are high in protein and low in sugar. To get enough glucose from this diet, dolphins have evolved a mostly harmless form of insulin resistance, according to Stephanie Venn-Watson, director of clinical research for the U.S. nonprofitNational Marine Mammal Foundation(

Sunday, February 21, 2010

In Ahead of the Curves, the author told of the story he heard of Jacques Chirac and his pact with West African marabouts, witch doctors. He was told to sacrifice one of his daughters if he wanted his presidency. Soon after his younger daughter, began suffering from anorexia nervosa.

Sixteen years ago, during her father's second presidential campaign, she was taken to hospital amid widespread rumours that she had died.

"Being famous can be harmful when one is faced with illness," Mrs Chirac said. "Confronting this kind of difficulty, you just want to hide from the gaze of others."

Laurence, whose younger sister Claude is a key member of the president's team at the Elysée, continued to suffer from the condition. In 1990 she tried to commit suicide by jumping out of the window of her fourth-floor flat.

A nurse assigned to her round-the-clock care was unable to stop Miss Chirac, who survived with a broken pelvis and head injuries.

Little has been heard of her since and Mrs Chirac said merely that she always kept the hope "pinned to my heart" that her daughter would recover.

Mrs Chirac has been the president since 1994 of a charity seeking to create better conditions for children and teenagers in hospital, enabling them to listen to or play music and play sports. She agreed to talk about her daughter on a France 3 discussion programme, “You Cannot Please Everyone”, to help publicise a new clinic for adolescents,La Maison de Solenn, funded by her charity.

"These children need some gaiety in their lives, to be able to see the sun," said Mrs Chirac,

She contrasted this ideal with the conditions in which her daughter was sometimes treated, "enclosed behind brick walls in a bedroom with a small window". She added: "That is why this mother wants to create a facility specific to adolescents' needs.

Thursday, February 18, 2010

“It's a strange irony that it is managers who seem intent on trying to turn us from public servants with a genuine interest in patient care into the money grabbing people the HSJ likes to portray us as. Managers were the ones who essentially forced new contracts onto consultants resulting in our being paid for the very first time (on paper anyway) for all the work that we do. Doctors who were reluctant to move from a professional and vocational contract are now being paid more. Did our masters expect us to be paid less? Perhaps they really did. Perhaps managers just cannot grasp that doctors do whatever is necessary to meet the vital needs of our patients whether we are paid or not. And the same people made similar mistakes with GPs. For it was managers who forced GPs to jump through ever more hoops to be paid - which they promptly did. The BMA dutifully told the government that it would result in their being paid more. But the BMA was not believed. Yet the HSJ continues to distrust them.”

The BMA represents 70% of all doctors and the vast majority oppose a market based healthcare system (there are several surveys that prove this). As a member of BMA Council, I and my fellow Council members were mandated to mount a campaign against the market based reforms by several motions passed overwhelmingly at consecutive Annual Representative Meetings (ARM). I also happen to passionately believe that this was the right thing to do. Even Gordon Brown (SMF speech 2004) understands that markets don't work well in some situations and healthcare is one of the best examples of this.

As for big business profiting from the NHS, why not take a look at the Forbes website, Mr Vize:

US companies involved in the NHS (all FESC approved for example):Humana.Current CEO: Michael.B.Mccallister

Here are some further astonishing figures including other top execs (see further down page):The Industry Radar

The HSJ should be investigating these characters instead of slagging off the BMA. These companies want to expand their markets into the UK and their number one priority is to their shareholders, not the English taxpayer and patients. That is why the BMA is fighting so hard against this.

As for GPs being small businesses, that may be the case, but they are a vitally important part of the communities they serve. Most GP partners work in their practices for their entire working lives and therefore have unprecedented knowledge about their patients and patients' families, which is vitally important for continuity of care. The vast majority are wedded to the ideal of the NHS and most are very innovative. Mr Vize's comments about GP's IT illiteracy are unfounded. In fact, GPs are miles ahead of the hospital sector in terms of successful use of IT.

Poor GP services do need sorting out, but Polyclinics are not the answer. The for-profit GP outfits will try to increase profits by employing cheaper staff on short term contracts. This will have dreadful consequences for continuity of care. It will be the poorest and most vulnerable patients with chronic long term illness who will lose out to the worried well who want to pop into clinic after work, who don't really mind who they see.

Wednesday, February 17, 2010

Plutus, the Greek god of wealth, did not have an easy life. As the myth goes, Plutus wanted to grant riches only to the "the just, the wise, the men of ordered life." Zeus blinded him out of jealousy of mankind (and envy of the good), leaving Plutus to indiscriminately distribute his favours.

Greece's dysfunctional economy is now at the heart of a rescue effort that could be disastrous for the entire continent—and the rest of the world.

Modern-day Greece may be just and wise, but it certainly has not had an ordered life. As a result, the great opportunity and wealth bestowed by European integration has been largely squandered. And lower interest rates over the past decade—brought down to German levels through Greece being allowed, rather generously, into the euro zone—led to little more than further deficits and a dangerous build-up of government debt.

Now Plutus wants his money back. Europe is entering unprepared into a serious economic crisis—and the nascent global recovery could easily collapse due to the unsustainable and Ponzi-like buildup of government debt in weaker countries.

At the end of the G7 meeting in Canada last weekend, Treasury Secretary Tim Geithner told reporters, "I just want to underscore they made it clear to us—they, the European authorities—that they will manage this [Greek debt crisis] with great care."

But the Europeans have not been careful so far. The issues for troubled euro zone countries are straightforward: Portugal, Ireland, Italy, Greece and Spain (known to the financial markets, and not in a polite way, as the PIIGS) had varying degrees of foreign- and bank credit-financed rapid expansions over the past decade. In fall 2008, these bubbles collapsed.

Exclusive: GPs are being told to refer thousands of patients to the private sector to bail out a Government scheme to outsource services from hospitals, Pulse can reveal.

A group of 10 PCTs is insisting practices send patients to services run by the company Care UK, after it emerged they were currently seeing fewer than a third of the projected number of referrals.

GPs have been warned they could even face action from theGMCif they refuse to refer patients en masse to the company.

Trusts who will foot the bill from theDepartment of Health’s contract, which pays Care UK a block sum even if services are under-used, are warning they face dire financial consequences if they cannot ensure GPs refer to the private facilities rather than local services.

It comes after Derby City PCT admitted offering payments to GPs to send patients to an independent sector treatment centre in its area.

“Face action from the GMC!!!”

For doing what all doctors have been trained to do: the right thing!!!

Then I remembered what I heard and saw in Cambodia: that all the doctors were slaughtered during the Khmer Rouge era together with other intellectuals. It was not easy to determine the number of people killed. Most put it at 2 million and right now there are very few over 65s and even fewer people wear glasses in the country.

Thank you for your visit.

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A budding child psychiatrist

About Me

Before my retirement, I practised child psychiatry for 30 years, 25 of which as a consultant and director. After these years of clinical practice, I felt compelled to tell my stories as I have my doubts as to the validity of some of the assertions of the medical world.
I am the author of the book The Cockroach Catcher, which is based on my work as an NHS child psychiatrist. Contact me on: cockroachcatcher at gmail dot com

Eric Kandel, M.D., who was awarded the Nobel Prize in 2000 for discovering molecular mechanisms of memory storage, told the crowd at last ...

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